Plan for Webinar 2/26/2015. Copyright LSVT Global, Inc Greetings from New York City and Kentucky!

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1 Crucial Questions: Insurance Coverage and Considerations for LSVT LOUD and LSVT BIG This work was supported, in part, by the: National Institutes of Health - R01 DC01150, R21DC006078, R21 NS043711, Michael J. Fox Foundation, Parkinson Alliance and Davis Phinney Foundation Plan for Webinar Logistics Brief Review Resources Available Address your questions Greetings from New York City and Kentucky! Jessica Galgano, PhD, CCC-SLP Executive Director, Open Lines Speech and Communication Faculty Instructor, New York University Langone School of Medicine Laura Gusé, MPT, MSCS LSVT BIG Expert Clinician Chief Clinical Officer LSVT BIG LSVT BIG Training and Certification Faculty, LSVT Global, Inc. Copyright LSVT Global, Inc

2 Instructor Biographies Jessica Galgano, PhD, CCC-SLP Dr. Galgano received her doctoral degree in Biobehavioral Sciences from Columbia University in NYC. Dr. Galgano conducts research in the area of neurologic communication disorders and the neurophysiologic underpinnings of normal, aging, and pathologic voice production using neuroimaging techniques such as EEG and fmri. She is an associate research scientist at NYU School of Medicine and Executive Director of Open Lines Speech and Communication in NYC, where she provides LSVT LOUD and other types of therapy to adults and children with a wide variety of speech and language diagnoses. Dr. Galgano conducted research with Dr. Ramig at Columbia University and is a faculty member and workshop leader for LSVT Global, Inc. Laura Gusé, MPT, MSCS Ms. Guse received her Master s Degree in Physical Therapy at the University of North Dakota in Ms. Guse has worked extensively in the area of neurodegenerative and neurological disorders both in outpatient and inpatient settings. She specializes in treatment of Parkinson disease and multiple sclerosis. She is certified in LSVT BIG, and is the LSVT BIG Chief Clinical Officer for LSVT Global, Inc. Disclosures Ms. Guse and Dr. Galgano receive lecture honorarium and travel reimbursement from LSVT Global, Inc. as faculty for LSVT BIG Training and Certification Workshops. Ms. Guse is an employee of LSVT Global, Inc. STATEMENT ON DISCLOSURE AND CONFLICT: All members of this research team have fully disclosed any conflict of interest (Ramig and Fox) and their conflict of interest management plan has been approved by the Office of Conflict of Interest and Commitment at the University of Colorado, Boulder. Health Care Today Costs have gone up for patients, providers, and insurance entities Copyright LSVT Global, Inc

3 Payment Options for Therapy Services Insurance Medicare Medicaid Private Both Cash based Both Learn About Your Insurance Policy Insurance regulations are complex both for the consumer and the provider Understanding what your insurance covers and does not cover is vital. Read and ask questions! Patients and providers both have key roles in supporting positive reimbursement patterns for therapy services. Treatment Planning: A Team Approach Provider s Role Educate on LSVT BIG and/or LSVT LOUD and other therapy options Provide skilled therapy intervention that is medically necessary Document well and comply with all regulations Give your patient the choice respect patient autonomy Patient s Role Listen to the provider s recommendations and education Make a choice based on information given and personal circumstances and values Follow through with treatment plan Copyright LSVT Global, Inc

4 How Do Patients Make Choices? LSVT Protocols are One Choice Effective Evidence-Based Functionally Relevant LSVT BIG and LSVT LOUD Evidence Based Treatment Protocols 4 Times per Week for 4 Weeks Minimum Individual One Hour Sessions Only delivered by LSVT BIG (PT/OT) and LSVT LOUD (Speech) Certified Clinicians Supported by 20+ years of NIH funded research establishing treatment efficacy Copyright LSVT Global, Inc

5 Can LSVT BIG or LSVT LOUD be delivered in fewer than 16 visits? NO Exercise is medicine. This is evidence based practice. Copyright LSVT Global, Inc

6 Stick to the Evidence LSVT Protocols ARE Reimbursable! Reimbursement is supported by: Research on LSVT protocols Clinical outcomes-consistent Functional Improvements Subjective Patient Reports and Surveys Reimbursement Considerations Do you have insurance? What does it cover/not cover? What is the appeals process? Do you have concerns about co-pays, coinsurance, out of pocket expenses, etc.? Do you have the ability to pay for part or all of the treatment? What choice will you make based on these considerations? What are the options? Copyright LSVT Global, Inc

7 Reimbursement Basic Principles: Insurance companies WILL pay (Medicare, United Health Care, Anthem/BCBS, Cigna, Oxford, Kaiser ) You WILL get denials. Do not panic! This does not mean you cannot appeal and be reimbursed Reimbursement Obtain pre-authorization if necessary: Some insurance plans require prior authorization for evaluation and/or therapy services know this before you get into scheduling or you may not be reimbursed Know the company s policy: Insurance policies for speech therapy are available online. (Cigna s is extensive and specifically mentions the LSVT LOUD-Companion under computer based programs use that knowledge!) Reimbursement Make sure your therapist is prepared with documentation (evaluation and progress reports, MD notes, specific LSVT prescription, letter of medical necessity) and take advantage of appeals processes Some insurers have peer-to-peer discussion with medical director available Sometimes it is simply a coding issue Copyright LSVT Global, Inc

8 Medicare Awareness of Medicare cap is important The 2015 therapy cap is $1940 for ST and PT combined. Cost for therapy requires use of the KX modifier: When you qualify for a medically necessary therapy cap extension, this modifier is required on the claim form. Occupational Therapy (OT) has its own $1940 cap separate from PT/ST When services for ST and PT combined reach a $3700 threshold, claims will be stopped and subject to a manual medical review to prove medical necessity above the cap. There is also a limit to the extension. Therapy or billing staff can look this up for you. Cash Based Services Communication and Function are of great value. LSVT eloud Telepractice LSVT LOUD Companion Funded by: NIH-NIDCD & Michael J. Fox Foundation Copyright LSVT Global, Inc

9 Reimbursement for LSVT eloud LSVT eloud Telehealth/Telemedicine Varies state to state Check with individual policies Private pay may be an alternative Take Home Points Really learn about your insurance policy and ask questions. Seek treatment options that are evidence based. Use your $ wisely. LSVT BIG and LSVT LOUD are reimbursable and have great value. You are important in achieving successful reimbursement for therapy simply by following the plan of care so you achieve good outcomes. There may be situations where you have to make decisions about treatment options. You have in important voice to make positive changes in healthcare! Further Information and Resources Webinars - Clinician and PD Community LSVT Clinician Directory FAQs LSVT BIG and LSVT LOUD Homework Helper DVDs LSVT LOUD Companion Home Edition Future Development: LOUD for LIFE and BIG for LIFE Copyright LSVT Global, Inc

10 Thank you! Questions??? Copyright LSVT Global, Inc

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